Accuracy of cone-beam CT in detecting vertical root fractures in teeth with post-endodontic restorations: an in vitro study

Abstract

The aim of this study was to evaluate the accuracy of cone-beam CT (CBCT) for the detection of artificially created vertical root fractures (VRF) in extracted teeth restored with metallic (MP) and fiberglass (FGP) posts. After root canal obturation, 60 extracted human premolars were scanned by using the highest-resolution settings of a CBCT unit. The prepared roots were randomly divided into three groups: group C (control group): non-restored and non- endodontically treated teeth (n = 20); group MP (n = 20); group FGP (n = 20). In all groups, 10 teeth were artificially fractured. Two external and independent observers blindly recorded the presence or absence of VRF. Sensitivity, specificity, accuracy, intra- and interobserver agreement were calculated. Kappa value for inter- and intraobserver agreement was 0.82 and 0.84 respectively, demonstrating good agreement. The highest values for sensitivity (0.80 - 0.90), specificity (1.00) and accuracy (0.90 - 0.95) were found in the control group. The teeth with FGP restoration presented the lowest sensitivity (0.30 - 0.50) and accuracy (0.60 - 0.65) values. Both examiners had a good performance in the diagnosis of fractures in teeth with MP, with accuracy ranging between 0.85 - 0.90. The presence of MP did not influence accuracy; however, the presence of FGP reduced the diagnostic capacity of CBCT.